ABSTRACT
Atrial fibrillation (AF) is common and is a prominent risk factor for ischemic stroke. Oral anticoagulant (OAC) therapy has been the main strategy for stroke prevention in AF patients; however, OAC therapy carries a bleeding risk and is not tolerated by all patients. Left atrial appendage (LAA) closure offers a non-pharmacological alternative for stroke prevention in patients with non-valvular AF. In this update, an overview of current and emerging LAA occluders is given - with special attention to the key design features of every single device and, if available, preclinical or clinical data.
Subject(s)
Atrial Appendage , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Stroke/prevention & control , Animals , Atrial Appendage/physiopathology , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Cardiac Catheterization/adverse effects , Equipment Design , Humans , Risk Factors , Stroke/diagnosis , Stroke/etiology , Stroke/physiopathology , Treatment OutcomeABSTRACT
Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis. The optimal treatment strategy for concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. This study aimed to describe the degree of CAD, revascularization strategies, and long-term clinical outcomes in a large-scale all-comers TAVR-population. Nine hundred and forty-four consecutive patients underwent TAVR. Obstructive CAD was reported in 224 patients (23.7%)-of these, 150 (66.9%) presented with one-vessel disease (1-VD), 51 (22.8%) with 2-VD, and 23 (10.3%) with 3-VD. Two-thirds underwent coronary revascularization before TAVR; half of those patients with 1-VD and only one-third of those with multivessel disease were completely revascularized. In general, borderline stenoses (50%-70%) were more frequently revascularized in proximal coronary segments than in more distal segments. Long-term survival rates by Kaplan-Meier analysis of the total TAVR population at 5 and 9 years were 64.7% and 54.1%, respectively. A diagnostic coronary angiography was performed in 16.5% of patients within 5 years after TAVR; only 4.8% underwent consequent percutaneous coronary intervention (PCI). There was no difference in survival and need for revascularization post-TAVR between those patients with or without obstructive CAD ± revascularization. Neither was there a survival difference between those with or without previous CABG and/or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary revascularization.
Subject(s)
Aortic Valve Stenosis/surgery , Coronary Artery Disease/therapy , Coronary Stenosis/therapy , Myocardial Revascularization , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/mortality , Denmark/epidemiology , Female , Humans , Male , Myocardial Revascularization/adverse effects , Myocardial Revascularization/mortality , Prevalence , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/mortality , Treatment OutcomeABSTRACT
Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate-risk patients with severe symptomatic aortic stenosis (AS). Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a "gothic aortic arch"; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair.
Subject(s)
Aorta, Thoracic/injuries , Aortic Valve Stenosis/surgery , Aortic Valve/abnormalities , Blood Vessel Prosthesis Implantation/methods , Heart Valve Diseases/surgery , Intraoperative Complications , Transcatheter Aortic Valve Replacement/adverse effects , Vascular System Injuries/etiology , Acute Disease , Aged, 80 and over , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnosis , Bicuspid Aortic Valve Disease , Female , Humans , Multidetector Computed Tomography , Rupture , Stents , Vascular System Injuries/diagnosis , Vascular System Injuries/surgerySubject(s)
Atrial Appendage/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Imaging, Three-Dimensional , Patient-Specific Modeling , Tomography, X-Ray Computed , Atrial Appendage/physiopathology , Atrial Fibrillation/physiopathology , Echocardiography, Transesophageal , Equipment Design , Humans , Predictive Value of Tests , Radiographic Image Interpretation, Computer-AssistedSubject(s)
Heart Neoplasms/complications , Intracranial Aneurysm/complications , Intracranial Embolism/etiology , Myocardial Infarction/complications , Myxoma/complications , Female , Heart Atria/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Humans , Middle Aged , Myxoma/diagnostic imaging , UltrasonographyABSTRACT
BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.
